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Form of workScope of Responsibilities: Assist with the day-to-day operations of the Clinical Pharmacist and clinical department of ProAct. Works under direct supervision and follows standard procedures to accomplish assigned tasks.
Job Summary: Responsibility for overseeing the prior authorization process, initial prior authorization review, and assisting with tasks and goals that meet the clinical needs of ProAct clients and members.
ResponsibilitiesJob Duties:
- Oversee the prior authorization process to maintain efficiency and timeliness.
- Review prior authorization requests based on currently-available guidelines
- Provide Help Desk support, where appropriate, for questions regarding overrides or system edits
- Responsible for working with Implementation Department for loading prior authorization data for new clients when appropriate
- Assist in preparation of member mailings for various cost containment/clinical programs.
- Assist both members and Noble Health Services in finding most cost-effective channels for specialty medications
- Maintain records of all prior authorizations completed by ProAct
- Providing reports on monthly basis
- Providing data for Accounting Department for invoicing
- Assist in the development and updating of formulary documents
- Responsible for completing all mandatory and regulatory training programs
- Assist with the day-to-day operations of the ProAct Help Desk
- Perform other duties as assigned
Attendance Requirements:
- Must be available, and on-time for scheduled work shifts
Educational Requirements:
- Minimum: High School Diploma (or currently enrolled) or GED
- Preferred: AS Degree or Higher
- National Pharmacy Technician Certification through PTCB, or other accrediting agency, in good standing.
Experience:
- Preferred hospital or retail pharmacy experience preferred
Special Conditions of Employment:
- Drug test
- Initial and continuous exclusion and sanction/disciplinary monitoring
- Any and all additional eligibility requirements based on the specific position
Required Training:
- HIPPA Privacy Course and CE Mastery Exam
- HIPPA Security Course and CE Mastery Exam
Job Skills Required:
- Strong Communication Skills: Must be able to effectively communicate both on the phone and in group setting
- Strong Organizational Skills
- Proficient in using Microsoft Excel, Word, and Access
- Must be able to work independently
Behavioral Traits:
- Cooperation: Must work harmoniously and effectively with fellow employees, supervisors and other in contact with
- Initiative: Must work within supervision guidelines and assume additional responsibilities
- Flexibility: Must be willing to work variable work schedules, assist others as requested and available, and be willing to perform all assigned work
- Adaptability: Must respond to new situations in a positive way, accept change, support new ideas, master new routines and grasp explanations, apply current knowledge in new environments and experiences
- Involvement: Must enjoy the demands of the job and work with interest and enthusiasm
- Customer Service: Must provide appropriate customer service (for Kinney customers, fellow employees and business partners), listen attentively to their needs and respond appropriately
- Safety: Must take care of equipment and employ good safety habits
- Leadership: Must gain acceptance of ideas and accomplish goals through subordinates, peers and teams
Compensation:
$17.76 - 19.31 an hour
The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.
KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.
Employment Type: FULL_TIME
